title: The association between cortisol response to mental stress and high-sensitivity cardiac troponin T plasma concentration in healthy adults.
abstract: OBJECTIVE
  The objective of this study was to examine the association between cortisol response to mental stress and high-sensitivity cardiac troponin T (hs-cTnT) in healthy older individuals without history of cardiovascular disease (CVD).
  
  
  BACKGROUND
  Mental stress is a recognized risk factor for CVD, although the mechanisms remain unclear. Cortisol, a key stress hormone, is associated with coronary atherosclerosis and may accentuate structural and functional cardiac disease.
  
  
  METHODS
  This cross-sectional study involved 508 disease-free men and women aged 53 to 76 years drawn from the Whitehall II epidemiological cohort. We evaluated salivary cortisol response to standardized mental stress tests (exposure) and hs-cTnT plasma concentration using a high-sensitivity assay (outcome). We measured coronary calcification using electron-beam dual-source computed tomography and Agatston scores.
  
  
  RESULTS
  After adjustment for demographic and clinical variables associated with CVD as well as for inflammatory factors, we found a robust association between cortisol response and detectable hs-cTnT (odds ratio [OR]: 3.98; 95% confidence interval [CI]: 1.60 to 9.92; p = 0.003). The association remained when we restricted the analysis to participants without coronary calcification (n = 222; OR: 4.77; 95% CI: 1.22 to 18.72; p = 0.025) or when we further adjusted for coronary calcification in participants with positive Agatston scores (n = 286; OR: 7.39; 95% CI: 2.22 to 26.24; p = 0.001).
  
  
  CONCLUSIONS
  We found that heightened cortisol response to mental stress was associated with detectable plasma levels of cTnT using high-sensitivity assays in healthy participants, independently of coronary atherosclerosis. Further research is needed to understand the role of psychosocial stress in the pathophysiology of cardiac cell damage.
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom. Electronic address: a.lazzarino@ucl.ac.uk.
authors.forename: Antonio I
authors.initials: AI
authors.lastname: Lazzarino
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Hamer
authors.affiliation: Chemical Pathology, Clinical Blood Sciences, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Gaze
authors.affiliation: Chemical Pathology, Clinical Blood Sciences, St. George's Healthcare NHS Trust, London, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: Collinson
authors.affiliation: Department of Epidemiology and Public Health, University College London, London, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Steptoe
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012463:Saliva / Q000737:chemistry*; D013315:Stress, Psychological / Q000378:metabolism*; D014057:Tomography, X-Ray Computed; D020107:Troponin T / Q000097:blood*
chemical_list: D020107:Troponin T; D006854:Hydrocortisone
keywords: AMI; BMI; C-reactive protein; CAC; CRP; CVD; HDL; IL; LDL; acute myocardial infarction; atherosclerotic plaque; body mass index; cardiovascular disease; computed tomography; coronary artery calcification; high-density lipoprotein; high-sensitivity cardiac troponin T; hs-cTnT; interleukin; low-density lipoprotein; myocardial infarction; psychological stress; troponin T